Clinical Insurance Specialist in the Pre-Doc GP5 Clinics Position Control Number CIS-22-305-01

U M FDSP Associates PA•Baltimore, MD

33d•Onsite

About The Position

Under general supervision, accurately and professionally clarifies and supports the administrative requirements of the various commercial patient dental insurance plans. Additionally, is accountable for a range of operational and administrative duties.

Requirements

High school diploma or general education degree (GED)
1 - 3 years’ related experience. Related education may be substituted for experience on a year for year basis.
Knowledge of commercial dental insurance policies, services, guidelines, and procedures.
Skilled in dental terminology.
Skilled in written disputes of non-payment for services due to processing errors.
Skilled in communicating insurance policies and procedures to patients and services providers.
Ability to ensure commercial dental insurance compliance and payment of services.
Ability to analyze insurance notification of changes in order to present plan participation recommendations to clinical financial administrator.
Ability to address complaints, grievances and appeals.

Nice To Haves

Knowledge commercial dental insurance policies, services, guidelines, and procedures.
Skilled in dental terminology.
Skilled in written disputes of non-payment for services due to DentaQuest processing errors.
Skilled in communicating dental insurance policies and procedures to patients and services providers.
Ability to ensure compliance with the various dental insurance providers and payment of services.
Ability to analyze dental insurance notification of changes in order to present plan participation recommendations to clinical financial administrator.
Ability to annotate the oral dentition.

Responsibilities

Investigate and research information to resolve dental insurance discrepancies.
Handle incoming calls including the processing of credit card payments over the phone.
Coordinate with Business Manager, Account Specialists, and Program Assistants the required dental insurance paperwork and dental x-ray documentation.
Contact the various dental insurance companies by phone to obtain missing or incomplete information so that accounts will be billed correctly.
Update Axium with new dental insurance plans as needed.
Verify patient dental insurance eligibility with numerous insurance companies including Medicaid.
Update patient dental insurance and personal information as needed.
Update third party liability through Medicaid to ensure the latest dental insurance revisions.
Obtain pre-authorizations from insurance companies to ensure patient is eligible for treatment prescribed by doctor.
Manage patient dental insurance plans and contracts including patient records, insurance templates, and master files.
Rebill treatment and planned treatment to current insurance.
Run insurance A/R report monthly.
Coordinate with dental providers to obtain necessary information (i.e. narratives, treatment notes) in order to submit accurate claims and to resolve disputes/appeals.